Orthodontic evaluation & treatment

What is orthodontics?

Orthodontics involves the diagnosis, prevention, and treatment of dental and facial irregularities, which often result in “malocclusion”. After orthodontic treatment the child will have an improved bite, a healthier mouth, and attractive smile that can be kept for a lifetime.

What is malocclusion?
Malocclusion is the improper positioning of the teeth and jaws. It is a variation of normal growth and development, which can affect the bite, the ability to clean teeth properly, gum tissue health, jaw growth, speech development, and appearance.

What causes malocclusion?
Both heredity and environmental factors can play a role in developing malocclusions.

An example of an inherited trait is congenitally missing teeth because the permanent tooth did not form.

There are several environmental factors that can also have a large impact. For example, sucking of the thumb past the age of 5 or 6 years. The habit exerts pressure on the bone and teeth affecting the shape of the jaw and position of the teeth.

What information is needed to evaluate a developing malocculsion?
Diagnosis and treatment planning involves a clinical exam, photographs, two x-rays, and plaster study models. After gathering all the information it is shared and discussed with the child and parents in a private consultation with Dr. Carta. Then treatment can begin. It can be accomplished with the use of fixed and removable appliances depending on each child’s needs.

Photographs of the face provide a record of the child’s facial appearance prior to treatment.

Intraoral photographs provide a record of the child’s teeth prior to treatment. During treatment progress photographs will be taken.

The panoramic x-ray shows all the upper and lower teeth presently in the mouth as well as the developing permanent teeth within the jaws.

The cephalometic x-ray is used to study the relationship of the teeth and jaws to the face and skull.

Study models are plaster statues of the child’s teeth. Study models provide a baseline of the current relationship of the teeth, and the size and shape of the jaws. By taking measurement of teeth Dr. Carta can estimate the space requirements for the child’s complete set of adult teeth.

Orthodontic Appliances

Posterior (Back Teeth) Cross Bite

This occurs when the UPPER teeth are biting inside the LOWER teeth. Normally the upper teeth would be closer to the cheeks and slightly hiding the lower teeth.

What is used to correct a posterior cross bite?
A maxillary (upper jaw) expansion appliance.

Ideally when is the cross-bite corrected?
Between 4 and 6 years of age before the 6 year molars erupt.

What does the maxillary expansion appliance do?
The maxillary expansion appliance widens the palate moving the upper teeth out over the lower teeth allowing the teeth to bite normally.

Anterior (Front Teeth) Cross Bite
The top front teeth are behind the lower front teeth.

What is used to correct an anterior cross bite?
The child has a maxillary expansion appliance to which the child attaches the DELAIR FACIAL ORTHOPEDIC MASK.

The Delair facial mask stimulates a forward growth of the upper jaw. The mask is worn in the privacy of the child’s home.

A soft head/chin cap is worn while sleeping after completion of the Delair facemask treatment.

What is a bionator?

A bionator is an orthodontic and orthopedic removable appliance. It stimulates growth changes that can NOT be accomplished with regular braces.

What can a bionator do?
It can stimulate growth of the lower jaw to come forward to meet the upper jaw.
It allows the back teeth to erupt more and helps train the tongue to swallow properly.
It also positions the jaw forward for better function of the TMJ (jaw joint) and improves facial profile.

What are braces?

Braces are fixed appliances. Metal brackets are directly bonded to the teeth, and metal bands are cemented around the back molars. The brackets and bands are connected with an arch wire.

How do braces work?
By applying gentle pressure of the teeth are moved or stabilized into position.

Does it take extra time to keep them clean?
YES. Scrupulous home care while wearing braces is essential. Food and plaque collect easily around the braces. Therefore, it is important to brush after each meal or snack with special attention to the area between the bracket and the gum.

Do I have to be careful about the foods I eat?
YES. While wearing braces do not eat sticky foods, chew gum, hard candy, or bite into hard foods like apples or pizza crust.

What are orthodontic retainers?

Retainers are inserted after the active phase of orthodontic treatment has been completed. The retainers prevent the teeth from moving back to their old positions. The retention phase of orthodontic treatment is as important as the treatment phase. As you can see in the photo to the right, these retainers are typically clear.

Upper Retainers (Maxillary Final Retainer Upper)
The upper retainer is removable. Depending on each patient, the upper retainer is worn for 3 months or one year FULL TIME (all day and all night). The only time it should not be worn is during eating, playing contact sports, or swimming in the ocean, lake or river. When the retainer is not worn, place it in the appliance case, so it does not get lost or broken! Retainer rule: The retainer should be in the mouth or in the retainer case.

Lower Retainers (Simple Mandibular Retainer Lower)
The lower retainer is bonded on the tongue side of the lower anterior teeth. It is important NOT to eat sticky, chewy candy or chew gum while the bonded retainer is bonded on the teeth.

How long are the upper and lower retainers worn?
Retainers are worn until the wisdom teeth erupt or three months after the wisdom teeth have been removed. The evaluation of the wisdom teeth is usually done at 17 or 18 years of age.

Space Maintainers

When does a child need a space maintainer?
When a child prematurely looses a baby tooth before the adult is ready to erupt. Under every baby/primary tooth there is a developing adult/permanent tooth.

Why would a child prematurely loose a baby/primary tooth?
The primary teeth is:
-- Badly decayed, it can not be restored and must be removed.
-- Knocked out due to accident
-- Developed an abscess (infected) and must be removed.

Why is it necessary to place a space maintainer?
The space maintainer reserves space (keeps the space open) until it is time for the permanent /adult tooth to erupt.

What happens if no space maintainer is used?
The teeth drift into the open space blocking out the developing tooth under the gum. So when it is time for the adult tooth to erupt there will not be enough room for the tooth to come in.

What do space maintainers look like?

	“The Space Maintainer” Band and Loop A band and loop space maintainer holds the space open for one tooth.
	Groper Fixed Anterior Bridge Upper space maintainer with teeth -- saves space for adult teeth -- improves child's appearance -- child can speak more clearly
	The Nance Bilateral UPPER space maintainer -- Reserves space when teeth are prematurely lost on the upper right and upper left. -- Prevents the back molar from drifting forward
	Lingual Arch Bilateral LOWER space maintainer -- Reserves space when teeth are prematurely lost on the lower right and lower left -- Prevents the back molar from drifting forward
	A distal shoe space maintainer is used when the second primary molar is lost BEFORE the adult first molar has erupted. The appliance guides the eruption of the adult first molar.

What is a halterman?

A permanent (adult) molar during its eruption processs become “locked” into a position under the primary (“baby”) tooth in front of it. A custom made appliance called a Halterman is used to move the “locked” permanent tooth back. By doing this the tooth is moved back which “un-locks” and allows the permanent molar to erupt normally behind the last primary (“baby”) molar.

How does it work?
A band with a loop is cemented to the primary (baby) molar tooth that is present. A small orthodontic “button” is bonded to the exposed portion of the permanent (adult) molar that needs to be moved back. Then one circle of a figure eight orthodontic elastic is placed on the Halterman appliance which was cemented to the primary (baby) molar tooth and the other elastic circle is place on the button bonded to the permanent (adult) molar.

There is gentle force created by the figure eight orthodontic elastic and this gentle force moves the permanent (adult) molar back. The figure eight orthodontic elastic must be changed weekly. Once the permanent (adult) molar had moved back enough to expose the whole chewing surface of the permanent (adult) molar then the permanent (adult) molar will erupt into it’s proper position right behind the primary (baby) molar tooth. Once the chewing surface of the permanent (adult) molar has erupts level to the primary (baby) molar the appliance can be removed.

Habits

Thumb, finger, pacifier and other oral habits can become a problem if not stopped by a reasonable age. There can be orthodontic concerns due to the pressures applied to the teeth.

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